Madelung's disease was first described in 1846. Since then, approximately 200 patients have been reported in the literature. Its three main characteristics-typical location of the lesions, symmetry, and the diffusive nature of the fat-are more often found in men of Mediterranean descent. A clear association with alcohol abuse is reported, but the etiology remains uncertain. Patients usually complain of their cosmetic appearance, but treatment can be rendered for decreased neck motion and/or aerodigestive problems. Given the benign nature of the lesion, surgical debulking is the treatment of choice, with liposuction reserved for smaller lesions. A standard facelift pattern can be used for skin incisions and removal, with good cosmetic results.

The ultrasonic liposculpturing technique is currently gaining increasing popularity. Although ultrasound is an accepted part of our diagnostic medical practice, the way in which it interacts with solid living tissue is still a complex and unsolved biophysical problem. Very few studies, if any, have followed the effects of diffusion of this intriguing technique on the fields of biosafety and interaction mechanisms. We evaluate the results of our standard ultrasound liposculpturing technique in order to recognize the physical mechanism-thermal, cavitational, or "direct"-involved in the damaging process. Our microscopic analysis of sonicated adipose tissue confirms that ultrasound is highly selective in its action, producing disruption of macromolecules and cellular structures probably through microstreaming tissue movement. The results of ultrasonic liposculpturing and standard suction lipoplasty are compared. The main advantages of this new technique are the possibility of a very selective destruction of adipose tissue and the prospective solution to such delicate problems as the irregularity of cellulite.

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